Jump-Start a Healthy Heart

A simple 4-week plan designed to help even the busiest woman find out if her heart is healthy and learn how to prevent heart disease. Are you taking care of your ticker? Visit our Cook Your Heart Out center to assess your heart health.

This year, give yourself a valentine: Adopt a program to keep your heart strong. These tiny, easy steps pack research-backed power to stop cardiac disease — the number one killer of women. And while more of us than ever know about this major threat, we still aren't doing enough to fight it. In a recent UCLA study that tracked 17,061 middle-aged adults, women's blood pressure rose twice as much as men's each decade. A major reason? As women themselves told a recent American Heart Association survey, "family obligations and people to care for" get in the way of heart-smart living. Plus, too many of our doctors still underestimate the threat for women and fail to stress heart health in exams and health messages.

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That's why it's up to you. "Fighting heart disease isn't about getting a test once a year. It's about what you do on the other 364 days," says Susan Bennett, M.D., director of the Women's Heart Program at George Washington University and a spokesperson for the American Heart Association's Go Red for Women campaign. Here, the steps to help you get started.

Week 1: Learn Your Risks

When you get all the basics into line — blood pressure, cholesterol, weight, waist size, and not smoking — you can reduce your odds of having a heart attack or needing bypass surgery by 80 percent, says Noel Bairey Merz, M.D., medical director of the Women's Heart Center at Cedars-Sinai Medical Center in Los Angeles. And knowing your particular vulnerabilities lets you target risk-cutting strategies that will help most.

This Week

Measure your middle. A tummy pooch, even if you're not overweight, signals the presence of vicious visceral fat — blubber wrapped around internal organs that pumps hormones, inflammatory chemicals, and fatty acids to your heart, liver, and all your cells. This fat raises blood pressure, makes cells resistant to insulin, and accelerates the growth of gunky plaque in artery walls. How big is too big? In one Harvard study of over 44,000 women, a waist measuring 35 or more inches doubled the risk of dying early from heart disease, compared to one of less than 28 inches. Also, be sure to check your body mass index with our handy BMI calculator. If you're overweight, dropping as little as 10 percent of your weight cuts your risk, since belly fat is the first to go. Also, a combo of aerobic exercise and weight training best targets ab flab.

Fill in your family history. In a University of Texas Southwestern study of 2,404 people, a family history of premature heart attacks doubled a woman's odds of having plaque in her heart arteries. Which family member counts, too: Having a parent with heart disease raises your own risk significantly, especially if he or she was stricken young (before 55 for your dad, 65 for your mom). But because you share genes and often the same legacy of early eating and exercise habits with your siblings, if a brother or sister has heart disease, your risk is even greater, the landmark Framingham Heart Study has reported. This week, find out who in your family has or had heart problems, what kind, and at what age they began, then bring the info to your next doctor's visit.

Commit to giving up cigarettes. You probably know that smoking increases your risk of heart disease. But you may not realize that even social smoking — as few as one to four cigarettes a day — can almost triple your chances of a fatal heart attack. You can find help at numerous online sites, including the American Cancer Society, Go Red for Women, and American Lung Association. By the end of this week, choose your plan and mark a start date. You may discover that you need to enlist your doctor's help. A new study reported that almost 75 percent of current smokers trying to kick the habit are now highly nicotine dependent, a jump of 32 percent since 1989. It may be that cigarette manufacturers have been increasing nicotine levels, says Norman H. Edelman, M.D., chief medical officer of the American Lung Association. Or it could be that less-dependent smokers have already quit successfully, leaving a "hard core" group still looking for help. In any case, in order to avoid relapse, these people may well need intensive treatment.

Your Next Moves

You can't really understand your risk for heart disease — or use that information as a motivator — unless you know your numbers: blood pressure and cholesterol levels (including total, plus LDL and HDL cholesterol levels), your triglycerides, and your fasting blood sugar. If you've been tested within the past year, call your doctor's office for the results; then you can plug the numbers into the Go Red for Women Heart CheckUp to see where you stand. If you haven't been tested, schedule an appointment now. "And make sure that your doctor gives you real numbers," says Dr. Bennett. "Don't accept 'everything's fine.'"

Next: Make Over Your Diet

Week 2: Make Over Your Diet

Use these seven days to prove to yourself that heart-smart eating isn't daunting — or boring. Even small changes you make will add up: Research has shown, for example, that just half a cup of pinto beans a day can slash bad LDL cholesterol 8 percent or more in eight weeks. That's good for everyone — every 1 percent drop in your LDL can lower heart disease risk by up to 3 percent.

This Week

Transform breakfast. The trick is to opt for healthy versions of morning meals you already like and that go from pantry to plate in a flash. And since surveys show that we tend to eat more or less the same breakfast most days, a simple upgrade can make a big difference. Like toast? Make it with whole-grain bread (look for a loaf with at least 3 grams of fiber per slice and whole wheat at the top of the ingredients list). Cereal fans: Go for a whole-grain variety or an oat-based choice like Cheerios or oatmeal itself (even instant counts). Oats deliver heart-friendly soluble fiber. In one study that followed 9,776 women and men for 19 years, those who ate about 6 grams of soluble fiber a day (roughly the amount in a bowl of oatmeal, a half-cup of barley, and a pear) had a 15 percent lower risk of heart disease than those who consumed less than a gram a day.

Go for an oil change. Put away the butter, and start cooking with olive or canola oil, both of which are rich in monounsaturated fats. In one Norwegian study, eating more unsaturated fats (and less saturated) yielded healthier levels of LDL and heart-boosting HDL. "As long as you're not overeating, having good fats instead of butter and even instead of some carbohydrates like bread, pasta, or other starches is a heart-healthy eating strategy," says Washington, D.C., registered dietitian Mary Dickie, M.S., R.D., who counsels people at risk of heart disease. And if you haven't already banished trans fats from your menu, this is the week to do it. Reviled by cardiologists as "Frankenfats" because they clog and inflame arteries, trans fats still show up in many processed foods, especially baked goods. You can't go by the product label, since foods that deliver under 0.5 grams of trans fats per serving are legally permitted to claim no trans fats. Some nondairy creamers, for example, might be labeled 0 trans fats because they're under the 0.5 grams-per-serving limit. But use several of these to lighten your coffee, and you could get an unhealthy dose, says Dickie. "It's also hard to find trans fats on the ingredient list," she says. "Best is to avoid anything with shortening or partially hydrogenated oil."

Nibble a few nuts. Munching on walnuts, almonds, pistachios, or peanuts several times a week can make you 35 percent less prone to heart trouble. But the monounsaturated fats that make nuts heart-healthy can also pack on calories, Dickie notes. "Have a half-ounce with your breakfast cereal. You're less likely to overeat nuts then," she says. Or eat some with a piece of fruit or sliced veggies as a snack. "Their fat increases the absorption of nutrients in produce up to 18 times."

Add a fruit or vegetable to each meal. Your goal now is to get a good habit going. For breakfast, sprinkle berries on your cereal or have a sliced banana and peanut butter on toast; at lunch, enjoy carrot sticks or cherry tomatoes; for dinner, make a salad. Even drinking a glass of vegetable juice every day can help, researchers from the University of California, Davis, just found. In their study, more than half of the participants who drank one glass of vegetable juice a day got five daily veggie servings (meeting the guidelines of a heart-healthy eating plan), compared with less than a quarter of those who had no juice (everyone who had two daily glasses met the vegetable goals).

Once this week, try fish. The fish with the highest levels of EPA and DHA — the omega-3 fatty acids that lower inflammation and help protect against heart arrhythmias — is salmon. Choose farmed, wild, or canned (which is usually wild). Or try sardines, herring, mackerel, or lake trout. If you're not a fan of seafood, take fish-oil capsules (you want 1,000 milligrams of DHA plus EPA daily). Vegetarians can use an algae-based omega-3 supplement.

Your Next Moves

Ultimately, a heart-smart diet brims with vegetables and fruit, moderate portions of whole grains and lean protein (skinless poultry, lean beef, pork tenderloin), two servings of fish a week, and a couple of fat-free dairy servings a day (milk, yogurt). Add nuts, nut butters, olive oil, and a glass of wine if you like. You may not be able to vacation in Crete (where researchers found that eating this way slashed heart risk over 70 percent), but you can bring the Mediterranean diet to your table and enjoy the same heart benefits, even without the sunshine.

Next: Start Exercising

Week 3: Get Moving!

Regular activity cuts your heart attack risk — by 50 percent in one report — and lowers systolic blood pressure (the first number of your reading) an impressive five points with just three 10-minute walks three days a week, an Irish study shows. It also discourages the formation of blood clots and shrinks abdominal fat — and it's your best do-it-yourself strategy for raising heart-protective HDLs (in one report, exercise boosted HDLs by a respectable 3 to 9 percent).

This Week

Find 10-minute pockets in your day. "The cumulative time you put into short bursts of exercise is equivalent to one long workout," says Martha Gulati, M.D., assistant professor of preventive medicine in the cardiology division of Northwestern University Feinberg School of Medicine in Chicago. "The important thing is to start building an exercise habit." Keeping it manageable can up your odds of success, say researchers from the University of Bristol, England. In their study of 48 women on a walking program, participants who simply tried to add 2,500 steps a day did just about as well as women who set out to meet a 10,000-steps-per-day goal. Your aim this week is to get in three 10-minute walks (or two of 15 minutes apiece, or a 30-minute stroll) on five days.

Try pushing the pace (at least once). Ultimately, to reap the most cardiovascular benefits, you need to work out at a level that causes you to breathe a little harder and feel your heart beat faster. Keep it simple: Walk a little more briskly or choose a route with hills, Dr. Gulati suggests. The benefits can be dramatic. In a study of nearly 6,000 women who had some heart disease risk factors, she found that those who were sedentary were 57 percent more likely to die over nine years than the participants who were physically fit.

Your Next Moves

Eventually, you want to fit in aerobic exercise and strength training. In addition to walking, try swimming, biking, or any other activity that gets your heart rate up about three times a week. Add strength training (weight machines, hand weights, resistance bands, or even exercises that use your own body weight) twice a week to maintain muscle and burn more calories all day long.

Week 4: Knock Out Stress

Ongoing tension raises blood pressure and boosts levels of stress hormones, both of which can damage artery walls. Depression, which elevates body-wide inflammation and makes blood more likely to clot, can double a woman's heart attack risk, a long-term study from Johns Hopkins University has found.

This Week

Take this quiz: In the past two weeks, have you (1) had little interest or pleasure in doing things you normally enjoy or (2) felt down, depressed, or hopeless? If your answer to either question is yes, talk to your family doctor or ask for a referral to a mental-health counselor. Not only will airing your problems make you feel better, it will also help your heart — at the least, getting out from under depression will make it easier for you to eat right and exercise.

Call a close friend...or two...or three. When Swedish researchers tracked artery thickening in 102 women with heart disease, they found that those who were depressed and socially isolated had significantly more thickening than women who weren't depressed and who didn't feel cut off from other people.

Identify stress points in your life. Ten years ago, Duke University researchers found that stress hormone levels in working mothers stayed high from morning till night, instead of decreasing throughout the day, thus putting them at higher risk for heart attacks. This week, jot down when you feel stressed, then review your list to see if there's a pattern.

Your Next Moves

Once you know what sends your stress levels soaring, try to find solutions. You'll feel more in control — a proven stress buster itself. For problems you can't solve, techniques like yoga, meditation, dance, or exercise (running, walking) can make you feel stronger — and help protect your heart. In one study, people with heart disease who cut their stress levels were 74 percent less likely to die, have a nonfatal heart attack, or need bypass surgery.